Bioabsorbable Fixation of Scaphoid Fractures and Non-Unions; Analysis of Early Clinical Outcomes

Abstract

The vast majority of devices used for internal fixation of the scaphoid are metallic. This two-center study aimed to report the results of scaphoid fixation using a cannulated, bioabsorbable device made from a hydroxyapatite and poly-L-lactide composite in 29 consecutive patients. Fixation was performed for seven acute fractures and twenty-two established non-unions. Union was achieved in 72.4% of patients. Six of the acute fractures and fifteen of the non-unions united successfully. Modified Mayo Wrist Score ranged between good to excellent in all patients who successfully united, whereas patients who failed to unite ranged between poor to excellent, with one poor and two moderate scores. No adverse biocompatibility reactions were seen. Two failures with broken screws were re-explored and one of these was thought to be due to screw mal-placement. The device used is an alternative to conventional metal implants and produces comparable union rates to metallic devices in the short term.

Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Compression Screw

“…It was important, at the radiographic evaluation, an angle measurement: if the radio-lunate angle is greater than 30° and the radius scapholunate is greater than 60° 10 it was necessary to employ the Fisk-Fernandez technique to correct DISI 5 using a wedge graft bone from the iliac crest. For advanced degrees of SNAC or necrosis of the proximal pole other techniques may be indicated, such as rescue techniques, including the four corners arthrodesis, 4 resection of the first carpal row, radiocarpal arthrodesis, 17 pure scaphoid excision 18 or the pyrocarbon prosthesis, 4 , 17 , 19 considering the proper indication in each case.…”

“…Abassi et al 21 enumerated the advantages of screw fixation, including acute fractures, with accelerated rehabilitation and early return to work and good results. Ya'ish et al 17 described advantages in carrying out this fixation with bioabsorbable screws, as reduced risk of later removal of the implant, thus, avoiding the difficulties and risks of a surgery. According to Kirkham and Millar 13 fixation with compression screws in cases of DISI and cortical-cancellous bone graft is technically demanding.…”

Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods

“…[ 1 4 ] In order to avoid another operation for hardware removal and its potential-associated risks such as refracture, bioabsorbable plates, and screws were developed. [ 6 8 9 ] However, these bioabsorbable plates are usually much thicker than conventional metal plates in order to match the material strength. In hand surgery, thicker and bulkier plates are usually too cumbersome and impractical.…”

“…Bioabsorbable implants are being used with increasing frequency in the treatment of small bone fractures or fractures involving the joint surface. [ 6 7 8 9 ] Compared with conventional hardware, bioabsorbable implants are thought to provide gradual load transfer to the healing tissue, reduced need for hardware removal and radiolucency, which facilitates postoperative radiological evaluation. [ 10 ]…”

Use of biomaterials in scaphoid fracture fixation, a systematic review

“…Three studies used a prospective interventional approach with a PLLA derivative for fixation. Akmaz et al 17 used a combination of pin and screw fixation with self-reinforced polylactide (SR-PLLA), with Ya'ish et al 16 using fixation with combination PLLA and Hydroxyapatite. Yamamuro et al 20 used PLLA screw fixation.…”